[Schizophrenic psychosis in a patient with Gilles de la Tourette syndrome]

A 36 year-old female patient with schizophrenia and Tourette syndrome is described. Clinical course, present neurological and psychopathological state, results of psychological testing, computed tomography and MR tomography of the skull, EEG and evoked potentials are reported. Results of neurochemical analysis of CSF and plasma are presented. Possible relationships between Tourette syndrome and schizophrenia are discussed with particular reference to neurochemical findings.

Feline plague in New Mexico: risk factors and transmission to humans

The epidemiologic features of 60 cases of feline plague from 1977-1985 in New Mexico are reviewed. The most frequent clinical presentation was lethargy, anorexia, fever, and enlarged lymph nodes or abscesses. A history of hunting rodents was reported in 75 per cent of all cases. Five human plague cases were associated with five feline cases. Recommendations are presented for prevention of plague infection and transmission to humans, including restraining cats from roaming and hunting by neutering and keeping them indoors, treating them for fleas, and seeking medical care for febrile illnesses, especially when accompanied by enlarged lymph nodes.

Magnetic resonance imaging of the salivary glands. A comparison with computed tomographic scanning

A variety of diagnostic imaging techniques are currently available for the investigation of parotid gland disorders. At this time, for the investigation of mass lesions, computed tomography is the most valuable. Over the past several years, we have been comparing magnetic resonance imaging with computed tomographic scanning of our parotid gland lesions to evaluate the relative merits of both systems. This current study illustrates our current experience and shows the relative strengths and weaknesses of both methods.

Inheritance and testicular cancer. Arguments based on a report of 3 cases and a review of the literature

Cryptorchidism and antecedent contralateral testicular tumor formation are risk factors for the formation of testicular germ cell neoplasms. The question arises if familial occurrence of testicular cancer constitutes another risk factor. In a series of 184 patients, treated for testicular tumors, three pairs of non-twin brothers were recorded. The analysis of 82 cases reported in the literature to date as well as the clinical features of early age of onset, high incidence of bilateral testicular tumors in familial cases, ethnic differences in occurrence of testicular cancer, HLA studies and the detection of oncogenes give relevance to the concept of the participation of genetic factors in the etiology of testicular germ cell cancer.

Testicular tumors: presentation and role of diagnostic delay

180 patients with testicular germ cell tumors were evaluated in a retrospective study concerning the features of presentation and diagnostic delay. Mean duration of symptoms was 170 days, being different for seminoma and nonseminoma, and showing a continuous decrease since 1969. Duration of symptoms was longest in stage I seminoma. In the nonseminoma group the longest interval was observed in stage III. It is concluded that only in nonseminoma a prolonged delay exerts adverse effects on prognosis. Short delay (cryosperm conservation) does not seem to cause any harm. A plea is made for periodic testicular self-examination.

Treatment of childhood idiopathic thrombocytopenic purpura with Rhesus antibodies (anti-D)

We have recently reported that a rise of platelet numbers in ITP can be induced by blockade of the RES with antibody-coated red blood cells. We now present a collaborative study in which 15 Rhesus-positive children with ITP (nine boys and six girls aged 1-15 years) were treated with low-dose anti-D. Ten patients had chronic ITP (duration 6-47 months), five had acute ITP. Doses of 28-50 micrograms anti-D/kg bodyweight per course were given intravenously. In all patients clinical signs of bleeding ceased and platelet counts were elevated. An excellent, good or fair response with platelet increments of greater than 100, 50-100, or 20-50 X 10(9)/l, respectively, was observed in 19, 7, and 12 out of 45 courses in chronic ITP, and in 4, 1, and 2 out of 8 courses in acute ITP. The platelet increase (greater than 40 X 10(9)/l) persisted for 10 to over 360 days in chronic ITP. There were no untoward side reactions. Haemoglobin values remained stable in all patients but laboratory signs of mild, compensated haemolysis ensued. The direct antiglobulin test became positive in all cases due to anti-D IgG. Previous therapy of patients with chronic ITP included high-dose immunoglobulins and prednisone. These regimens were both effective but remissions were short. We conclude that anti-D therapy is an effective and safe form of treatment in childhood ITP.

[Instrument myopia as a possible source of error in nyktometer examinations]

In comparative studies covering 142 eyes a "night myopia" of 0.5 to 1.5 D was found in 33 eyes with the Nyktometer (Rodenstock) and in 23 eyes with the Mesoptometer I (Oculus). In 17 eyes the same degree of "night myopia" was determined with both instruments, while in 16 eyes it was found to be more severe when measured with the Nyktometer than with the Mesoptometer. In one eye this myopia was only found with the Mesoptometer. This more severe "night myopia" measured with the Nyktometer is probably attributable to "instrument myopia."

The treatment of delirium tremens and of incomplete alcoholic delirium--a brief history

Following the introduction of chlormethiazole for the treatment of delirium tremens a striking reduction in the death rate occurred. The mortality range in most statistics is 1-4%. The patient's age and complications concerning various internal organs affect the clinical outcome and so does the time at which chlormethiazole treatment is initiated. However, this has given rise to the habit of prescribing chlormethiazole at the slightest suspicion of the early stages of delirium tremens. In some cases the use of the drug was no doubt unnecessary, but equally certainly this measure has often prevented the development of complete delirium tremens which is now seen far more rarely than it was 20 years ago. The availability of this well-tolerated and easily controllable drug has made the treatment of most cases of delirium tremens a manageable task for any reasonably experienced physician. However, it should never be forgotten that delirium tremens is a life-threatening condition with many potential complications. Therefore, the initiation of any chlormethiazole therapy calls for careful monitoring by the physician.

Neonatal alloimmune thrombocytopenia due to fetomaternal Zwb incompatibility

A case of neonatal alloimmune thrombocytopenia due to fetomaternal incompatibility against the platelet-specific antigen Zwb (PlA2) is described. The antibody was of the IgG class and did not fix complement in vitro. Its specificity was established by panel identification and by comparison to a Zwb antiserum. Gene dosage determinations of Zwa antigens on platelets of parents and child revealed that the mother was homozygous Zwa Zwa, while father and child were heterozygous for this antigen.

Long-term ambulatory treatment of metastatic colorectal adenocarcinoma by continuous intravenous infusion of 5-fluorouracil

To delineate the efficacy of continuous intravenous 5-fluorouracil (5-FU) infusion therapy for advanced colorectal adenocarcinoma, a study of 36 patients with measurable metastatic disease was conducted. Patients received a daily intravenous infusion of 300 mg/m2 5-FU over a 24-h period utilizing portable infusion devices and central venous catheters. In a population characterized by substantial pretreatment exposure to radiotherapy, chemotherapy, and other indicators of poor prognosis, 13/36 (36%) patients achieved an objective response. An additional 10/36 (28%) patients manifested stable disease (no change) and experienced survival comparable to that of patients with objective response. Toxicity was minimal; patients were able to continue 5-FU infusions 95% of the total time on protocol. There were no adverse hematologic effects or catheter complications. Because previously untreated patients benefited more frequently (positive response, 50%), continuous intravenous infusion should be evaluated further as a primary modality option when 5-fluorouracil antitumor chemotherapy is contemplated.

High-dose intravenous immunoglobulin for post-transfusion purpura

Five patients with post-transfusion purpura (four due to Zw(a), one presumably due to HLA antibodies) were treated with intravenous immunoglobulin (IgG) at doses of 0.4 g per kg body weight. IgG therapy was immediately effective as indicated by cessation of bleeding and rise of platelet counts in four out of five cases.

Psychiatric reform in Italy--how does it work in Piedmont?

Psychiatric reform in Piedmont following new mental health legislation in Italy (1978) is described. The process of reform is characterised by a drastic reduction in psychiatric hospital populations and the setting-up of a new system of community-based services. The number of hospital admissions remains stable, but the character of inpatient care has changed. The reform involves problems of care for chronic patients.

[Italian psychiatry reform in the Piedmont region: Law no. 180 and its consequences]

Psychiatric reform in the northern Italian region of Piedmont following Law No. 180 is described. From 1977 to 1981 the overall psychiatric hospital inmate population is reduced from 5.544 to 2.396, the majority of patients discharged is now living in outpatient therapeutic communities, private psychiatric hostels and nursing homes. 76 community mental health centres with an average catchment area of 59.000 inhabitants and a medium of 250 patients as well as 21 psychiatric wards in general hospitals with a total of 253 beds are set up to substitute psychiatric hospitals. Inpatient admission and discharge numbers are stable in the years preceding and following law no. 180, private psychiatric hospitals decrease their proportion of total admission numbers from 49% (1975) to 40% (1980). Percentage of compulsory inpatient treatments falls from 30% (1975) to 6% (1980), duration of hospital treatment is drastically reduced. There is an integration of psychiatric services in the general health care system, utopic reform objectives have not been reached.

Platelet survival determined with 51Cr versus 111In

Optimal labelling conditions of human platelets with 111In-oxine were determined in vitro. Based on this optimized technique, platelet mean life span (MLS) and platelet sequestration site were comparatively evaluated in 79 patients with two labels, 51Cr (n = 26) and 111In (n = 53). Patients were subgrouped according to clinical criteria as autoimmune thrombocytopenic purpura (AITP) (group 1; n = 49), hypersplenism (2; n = 12), impaired thrombopoiesis (3; n = 3), unclassified thrombocytopenia (4; n = 6), and nonthrombocytopenic patients (5; n = 9). In patients with AITP and hypersplenism the mean values for the MLS determined either with 51Cr or with 111In were lowered but the difference was not statistically significant, neither for group 1 (18.6 h vs 17.3 h; P greater than 0.2) nor for group 2 (94.7 vs 122.3 h; P greater than 0.2). The correlation between MLS and platelet counts in patients with AITP was significant for both labels (P less than 0.001). The 15 min recovery tended to be higher with 111In in all groups, but the difference was significant (P less than 0.05) only for group 1. The sequestration sites were similar with both labels. We conclude that, contrary to previous reports, platelet survival studies yield similar results with both the 51Cr and 111In methods. Due to its distinct advantages 111In is the label of choice for investigation of platelet kinetics.

[Surgery in the aged--status and consequences]

Surgery in advanced age is encumbered with hazards for the patient ensuing above all from his polymorbidity. Accordingly, postoperative mortality may be up to 30 per cent and, in special cases (ileus), may even be as high as 80 per cent. Although many operations are performed and excellent results can be presented, alternatives to the prevailing attitude of taking the present situation for granted are feasible. Such alternatives are offered by a specific prophylaxis focussing in the younger patient on conditions which will require on operation anyway and which, as experience shows, will lead to serious complications in old age. If these consequences are taken into account, old people can be spared many an operation.

On the pathogenesis of spondylosis deformans and arthrosis uncovertebralis: comparative form-analytical radiological and statistical studies on lumbar and cervical vertebral bodies

To investigate the etiopathogenesis of the common clinical symptoms of the lower lumbar spine (LS) and cervical spine (CS) (lower back pain and local cervical spine syndrome), the dimensions of the third to fifth lumbar vertebral bodies (LVB) and the fifth to seventh cervical vertebral bodies (CVB) were studied quantitatively and morphometrically in frontal and sagittal planes, as a function of sex and age, in 105 human cadavers of both sexes aged between 16 and 91 years. The evaluation was done in X-ray pictures of 100-micron-thick polished bone sections with the aid of the Macro Facility of the Leitz Texture Analysis System. In each case, the maximum and minimum heights and widths and depths and the computed differences in heights, widths, and depths were determined. The results were evaluated statistically and compared within and between the two regions of the spine, using regression-correlation analyses. The heights, widths, and depths of the VB are all greater in men than in women; their behavior during ageing is, however, identical for both sexes. The heights of all the VB examined remain constant throughout life after termination of growth. The maximum widths and the width differences reveal an increase in both LVB and CVB in old age. All depth parameters reveal constancy in the case of the LVB but an increase in the case of the CVB in old age. The correlation coefficients of the maximum width of the VB within the spinal regions are very high in the LVB, but lower in the CVB. Between the two regions, in contrast, they are very low. This behavior suggests a superordinate action principle within each of the spinal regions which is based on characteristic anatomical construction and functional stressing. The static stressing of the LVB leads, laterally to disc protrusions. As a result of this, traction forces acting on the weak lateral elements of the anterior longitudinal ligament, stimulate the accretion of spondylotic osteophytes at the point of insertion of the ligament on the vertebral body. Anteriorly, in contrast, the particular strong anterior longitudinal ligament prevents such a remodelling process. Posteriorly, the longitudinal ligament is attached to the intervertebral discs, and can thus not stimulate the vertebral body to produce osteophytes. The dynamic stressing of the CVB leads laterally to friction between the VB in the region of the uncovertebral joints and to the formation of arthrotic osteophytes. Anteriorly, owing to the weak configuration of the anterior longitudinal ligament in this aspect, disc protrusion occur and, subsequently, spondylotic osteophytes accrete.